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Lolk K, Werenberg Dreier J, Christensen J. Individual and neighborhood-level socioeconomic deprivation and risk of epilepsy after traumatic brain Injury: A register-based cohort study. Epilepsy Behav 2024; 156:109807. [PMID: 38678986 DOI: 10.1016/j.yebeh.2024.109807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/21/2024] [Accepted: 04/21/2024] [Indexed: 05/01/2024]
Affiliation(s)
- Kasper Lolk
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Denmark; Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark.
| | - Julie Werenberg Dreier
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Denmark; Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark
| | - Jakob Christensen
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
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Grover S, Varadharajan N, Venu S. Urbanization and psychosis: an update of recent evidence. Curr Opin Psychiatry 2024; 37:191-201. [PMID: 38441163 DOI: 10.1097/yco.0000000000000931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
PURPOSE OF REVIEW Urbanization, a complex global phenomenon, has a significant bearing on schizophrenia/psychosis burden through various socioeconomic and environmental factors. This review focuses on recent evidence (2019-2023) linking urbanization, schizophrenia, and the role of green space. RECENT FINDINGS This review analyzed 43 articles that examined the correlation between urban birth or upbringing, urban living (urbanicity), and various schizophrenia/psychosis-related outcomes such as incidence, psychotic experiences, etc. The studies showed differing results across geographical locations. Socioeconomic factors like area deprivation, migrant status (ethnic density) and social fragmentation were independently associated with the risk of schizophrenia/psychosis irrespective of urbanicity. More recently, environmental factors such as green space reduction and air pollution have been explored in urban living conditions and were positively associated with an increased risk of schizophrenia/psychosis. SUMMARY There is a need for further investigation in low and middle-income countries. The impact of urbanization-related factors and green space on the risk of schizophrenia/psychosis calls for appropriate governmental commitments toward structured and healthy urban planning.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, Punjab
| | - Natarajan Varadharajan
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)
| | - Sandesh Venu
- Department of Psychiatry, Pondicherry Institute of Medical Sciences (PIMS), Kalapet, Puducherry, India
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Petrescu C, Mihalache OA, Vilciu C, Petrescu DM, Marian G, Ciobanu CA, Ciobanu AM. Clinical and Sociodemographic Correlations with Neurological Soft Signs in Hospitalized Patients with Schizophrenia: A Preliminary Longitudinal Study. Biomedicines 2024; 12:787. [PMID: 38672143 PMCID: PMC11048323 DOI: 10.3390/biomedicines12040787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/19/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
Schizophrenia is a severe, chronic neuropsychiatric disorder characterized by symptoms that profoundly impact behavior, cognition, perception, and emotions, leading to a reduced quality of life and physical impairment. Given the complexity of schizophrenia, there is a pressing need for clinical markers and tools to predict its course, enhance disease staging, facilitate early intervention, improve differential diagnosis, and tailor individualized treatment approaches. Previous studies focused on the relationship between neurological soft signs (NSS) and factors such as age, illness duration, and symptomatology, indicating NSS as state markers improving in parallel with psychotic symptom remission or predicting treatment resistance. However, there is a lack of consensus on NSS assessment tools, hindering routine clinical monitoring despite diagnostic and prognostic potential. The present longitudinal study involved 81 psychiatric inpatients diagnosed with schizophrenia. Patients were assessed at three time points: baseline, 1 month, and 6 months. The examination included the use of scales to evaluate psychotic and neurological symptoms, as well as the identification of adverse extrapyramidal reactions caused by neuroleptic treatment. The progression of NSS was correlated to both the symptomatology and the sociodemographic data of the patients. The main findings from the present investigation revealed a statistical correlation between NSS and psychopathological symptoms, especially with negative symptoms of schizophrenia. However, it is important to note that neuroleptic side effects only had a limited impact on NSS. Therefore, instead of being linked to extrapyramidal symptoms caused by neuroleptics, NSS appears to be more frequently related with symptoms of schizophrenia. Our findings provide further support for their strong association with the course of schizophrenia, independent of treatment side effects, thus emphasizing their potential as reliable assessment tools in both research and clinical settings.
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Affiliation(s)
- Cristian Petrescu
- Neuroscience Department, Discipline of Psychiatry, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Psychiatry, ‘Prof. Dr. Alexandru Obregia’ Clinical Hospital of Psychiatry, 041914 Bucharest, Romania
| | - Oana A. Mihalache
- Department of Doctoral Studies, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Neurology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.V.); (D.M.P.)
| | - Crisanda Vilciu
- Department of Neurology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.V.); (D.M.P.)
- Neurology Clinic, ‘Fundeni’ Clinical Institute, 022328 Bucharest, Romania
| | - Diana M. Petrescu
- Department of Neurology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.V.); (D.M.P.)
- Neurology Clinic, ‘Fundeni’ Clinical Institute, 022328 Bucharest, Romania
| | - Gabriela Marian
- Academy of Romanian Scientists, 927180 Bucharest, Romania;
- Department of Psychiatry and Psychology, ‘Titu Maiorescu’ University of Medicine, 040051 Bucharest, Romania
| | - Constantin A. Ciobanu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020022 Bucharest, Romania
| | - Adela M. Ciobanu
- Neuroscience Department, Discipline of Psychiatry, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Psychiatry, ‘Prof. Dr. Alexandru Obregia’ Clinical Hospital of Psychiatry, 041914 Bucharest, Romania
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Græsholt-Knudsen T, Rask CU, Lucas S, Bech BH. Exploratory assessment of parental physical disease categories as predictors of documented physical child abuse. Eur J Pediatr 2024; 183:663-675. [PMID: 37955746 PMCID: PMC10912441 DOI: 10.1007/s00431-023-05317-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/14/2023]
Abstract
Improved prediction of physical child abuse could aid in developing preventive measures. Parental physical disease has been tested previously as a predictor of documented physical child abuse but in broad categories and with differing results. No prior studies have tested clinically recognizable categories of parental disease in a high-powered dataset. Using Danish registries, data on children and their parents from the years 1997-2018 were used to explore several parental physical disease categories' associations with documented physical child abuse. For each disease category, survival analysis using pseudovalues was applied. When a parent of a child was diagnosed or received medication that qualified for a category, this family and five comparison families not in this disease category were included, creating separate cohorts for each category of disease. Multiple analyses used samples drawn from 2,705,770 children. Estimates were produced for 32 categories of physical diseases. Using Bonferroni-corrected confidence intervals (CIc), ischemic heart disease showed a relative risk (RR) of 1.44 (CIc 1.13-1.84); peripheral artery occlusive disease, RR 1.39 (CIc 1.01-1.90); stroke, RR 1.19 (1.01-1.41); chronic pulmonary disease, RR 1.33 (CIc 1.18-1.51); ulcer/chronic gastritis, RR 1.27 (CIc 1.08-1.49); painful condition, 1.17 (CIc 1.00-1.37); epilepsy, RR 1.24 (CIc 1.00-1.52); and unspecific somatic symptoms, RR 1.37 (CIc 1.21-1.55). Unspecific somatic symptoms were present in 71.87% of families at some point during the study period. CONCLUSION Most parental physical disease categories did not show statistically significant associations, but some showed predictive ability. Further research is needed to explore preventive potential. WHAT IS KNOWN • Few and broad categories of parental physical disease have been examined as risk factors for severe physical child abuse; no prior study has used several categories as predictors. WHAT IS NEW • Unspecific symptoms, ischemic heart disease, peripheral artery occlusive disease, stroke, chronic pulmonary disease, stomach ulcer/chronic gastritis, painful condition, and epilepsy all showed to be potential predictors, with unspecific symptoms being the most prevalent.
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Affiliation(s)
- Troels Græsholt-Knudsen
- Research Unit for Mental Public Health, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
- Department of Forensic Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Palle Juul Jensens Boulevard 175, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Olof Palmes Allé 43, 8200, Aarhus N, Denmark
| | - Steven Lucas
- Department of Women's and Children's Health, Uppsala University, Akademiska Sjukhuset, 751 85, Uppsala, Sweden
| | - Bodil Hammer Bech
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
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Suokas K, Kurkela O, Nevalainen J, Suvisaari J, Hakulinen C, Kampman O, Pirkola S. Geographical variation in treated psychotic and other mental disorders in Finland by region and urbanicity. Soc Psychiatry Psychiatr Epidemiol 2024; 59:37-49. [PMID: 37308692 PMCID: PMC10799825 DOI: 10.1007/s00127-023-02516-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/06/2023] [Indexed: 06/14/2023]
Abstract
PURPOSE In Finland, prevalence of schizophrenia is higher in the eastern and northern regions and co-occurs with the distribution of schizophrenia polygenic risk scores. Both genetic and environmental factors have been hypothesized to contribute to this variation. We aimed to examine the prevalence of psychotic and other mental disorders by region and degree of urbanicity, and the impacts of socio-economic adjustments on these associations. METHODS Nationwide population registers from 2011 to 2017 and healthcare registers from 1975 to 2017. We used 19 administrative and three aggregate regions based on the distribution of schizophrenia polygenic risk scores, and a seven-level urban-rural classification. Prevalence ratios (PRs) were calculated by Poisson regression models and adjusted for gender, age, and calendar year (basic adjustments), and Finnish origin, residential history, urbanicity, household income, economic activity, and physical comorbidity (additional adjustments) on an individual level. Average marginal effects were used to visualize interaction effects between region and urbanicity. RESULTS A total of 5,898,180 individuals were observed. All mental disorders were slightly more prevalent (PR 1.03 [95% CI, 1.02-1.03]), and psychotic disorders (1.11 [1.10-1.12]) and schizophrenia (1.19 [1.17-1.21]) considerably more prevalent in eastern and northern than in western coastal regions. After the additional adjustments, however, the PRs were 0.95 (0.95-0.96), 1.00 (0.99-1.01), and 1.03 (1.02-1.04), respectively. Urban residence was associated with increased prevalence of psychotic disorders across all regions (adjusted PR 1.21 [1.20-1.22]). CONCLUSION After adjusting for socioeconomic and sociodemographic factors, the within-country distribution of mental disorders no longer followed the traditional east-west gradient. Urban-rural differences, on the other hand, persisted after the adjustments.
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Affiliation(s)
- Kimmo Suokas
- Faculty of Social Sciences, Tampere University, Tampere, Finland, Arvo Ylpön katu 34 (Arvo 1), 33014.
| | - Olli Kurkela
- Faculty of Social Sciences, Tampere University, Tampere, Finland, Arvo Ylpön katu 34 (Arvo 1), 33014
- National Institute for Health and Welfare, Helsinki, Finland
- Laurea University of Applied Sciences, Vantaa, Finland
| | - Jaakko Nevalainen
- Faculty of Social Sciences, Tampere University, Tampere, Finland, Arvo Ylpön katu 34 (Arvo 1), 33014
| | - Jaana Suvisaari
- National Institute for Health and Welfare, Helsinki, Finland
| | - Christian Hakulinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Health and Social Care Systems, National Institute for Health and Welfare, Helsinki, Finland
| | - Olli Kampman
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Psychiatry, The Pirkanmaa Wellbeing Services County, Tampere, Finland
- Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden
- Faculty of Medicine, Department of Clinical Medicine (Psychiatry), University of Turku, Turku, Finland
- Department of Psychiatry, The Wellbeing Services County of Ostrobothnia, Seinäjoki, Finland
| | - Sami Pirkola
- Faculty of Social Sciences, Tampere University, Tampere, Finland, Arvo Ylpön katu 34 (Arvo 1), 33014
- Tampere University Hospital, Tampere, Finland
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Græsholt-Knudsen T, Rask CU, Lucas S, Obel C, Bech BH. Parental physical disease severity and severe documented physical child abuse: a prospective cohort study. Eur J Pediatr 2024; 183:357-369. [PMID: 37889291 PMCID: PMC10857964 DOI: 10.1007/s00431-023-05291-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/05/2023] [Accepted: 10/15/2023] [Indexed: 10/28/2023]
Abstract
Successful prevention of physical child abuse is dependent on improvements in risk assessment. The risk of abuse is assumed to increase when family stressors overcome resources. Severe physical disease can increase stress, and parental physical disease has been studied as a risk factor for physical child abuse, but with heterogeneous definitions. This study evaluated the relation between parental physical disease severity and severe documented physical child abuse. Models were based on data on children aged 0-17 years in Denmark between 1997 and 2018, and their parents. Severe documented physical child abuse was modeled as violence against a child registered by either health authorities in treatment or mortality registries, or police authorities in cases confirmed by the courts. Parental physical disease severity was modeled as the sum of Charlson Comorbidity Index scores for the child's parents. The causal connection was examined in two model types: a survival model comparing exposed with non-exposed children, adjusted for covariates at baseline, and a G-model, taking time-varying covariates, including income and parental psychiatric disease into account. Neither model showed an association between parental physical disease severity and severe documented physical child abuse, with RR 0.99 and 95% CI (0.93-1.05) for the survival model and RR 1.08 for the G-model (CI not calculated). Conclusion: In the model studied, parental physical disease severity was not a risk factor for severe documented physical child abuse. Individual categories of physical disease remain to be examined. Trial registration: The study was pre-registered on Open Science Framework, https://osf.io/fh2sr . What is Known: • Parental physical disease severity has been studied previously as a risk indicator of physical child abuse, but based on heterogeneous definitions. • Previous studies have not studied parental physical disease severity preceding physical child abuse. What is New: • Parental severe physical disease was not prospectively associated with severe documented physical child abuse in a survival model, a G-model and a number of sensitivity analyses, respectively. • Results should be replicated in samples from populations without universal health care, and using different categories of disease.
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Affiliation(s)
- Troels Græsholt-Knudsen
- Research Unit for Mental Public Health, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Aarhus, Denmark.
- Department of Forensic Medicine, Palle Juul-Jensens Boulevard 99, Aarhus University, 8200, Aarhus N, Aaurhus, Denmark.
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Palle Juul-Jensens Boulevard 175, 8200, Aarhus N, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Olof Palmes Allé 43, 8200, Aarhus N, Aarhus, Denmark
| | - Steven Lucas
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, 751 85, Uppsala, Sweden
| | - Carsten Obel
- Research Unit for Mental Public Health, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Aarhus, Denmark
| | - Bodil Hammer Bech
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Aarhus, Denmark
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Logeswaran Y, Dykxhoorn J, Dalman C, Kirkbride JB. Social Deprivation and Population Density Trajectories Before and After Psychotic Disorder Diagnosis. JAMA Psychiatry 2023; 80:1258-1268. [PMID: 37672257 PMCID: PMC10483380 DOI: 10.1001/jamapsychiatry.2023.3220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/09/2023] [Indexed: 09/07/2023]
Abstract
Importance People with psychosis are more likely to be born and live in densely populated and socioeconomically deprived environments, but it is unclear whether these associations are a cause or consequence of disorder. Objective To investigate whether trajectories of exposure to deprivation and population density before and after diagnosis are associated with psychotic disorders or nonpsychotic bipolar disorder. Design, Setting, and Participants This nested case-control study included all individuals born in Sweden between January 1, 1982, and December 31, 2001, diagnosed for the first time with an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) psychotic disorder or nonpsychotic bipolar disorder between their 15th birthday and cohort exit (December 31, 2016). One sex- and birth year-matched control participant per case was selected. Data analysis was performed from July 2021 to June 2023. Exposures The main exposures were quintiles of neighborhood-level deprivation and population density each year from birth to age 14 years and from first diagnosis until cohort exit. Main Outcomes and Measures The main outcomes were the odds of a serious mental illness outcome associated with trajectories of deprivation and population density, before and after diagnosis in cases. Group-based trajectory modeling was used to derive trajectories of each exposure in each period. Logistic regression was used to examine associations with outcomes. Results A total of 53 458 individuals (median [IQR] age at diagnosis in case patients, 23.2 [15.0-34.8] years; 30 746 [57.5%] female), including 26 729 case patients and 26 729 control participants, were studied. From birth to early adolescence, gradients were observed in exposure to deprivation and population density trajectories during upbringing and psychotic disorder, with those in the most vs least deprived (adjusted odds ratio [AOR], 1.17; 95% CI, 1.08-1.28) and most vs least densely populated (AOR, 1.49; 95% CI, 1.34-1.66) trajectories at greatest risk. A strong upward mobility trajectory to less deprived neighborhoods was associated with similar risk to living in the least deprived trajectory (AOR, 1.01; 95% CI, 0.91-1.12). Only 543 case patients (2.0%) drifted into more deprived areas after diagnosis; people with psychotic disorder were more likely to belong to this trajectory (AOR, 1.38; 95% CI, 1.16-1.65) or remain in the most deprived trajectory (AOR, 1.36; 95% CI, 1.24-1.48) relative to controls. Patterns were similar for nonpsychotic bipolar disorder and deprivation but weaker for population density. Conclusions and Relevance In this case-control study, greater exposure to deprivation during upbringing was associated with increased risk of serious mental illness, but upward mobility mitigated this association. People with serious mental illness disproportionately remained living in more deprived areas after diagnosis, highlighting issues of social immobility. Prevention and treatment should be proportionately located in deprived areas according to need.
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Affiliation(s)
- Yanakan Logeswaran
- PsyLife Group, Division of Psychiatry, University College London, London, United Kingdom
| | - Jennifer Dykxhoorn
- PsyLife Group, Division of Psychiatry, University College London, London, United Kingdom
- Department of Primary Care and Population Health, UCL, University College London, London, United Kingdom
| | - Christina Dalman
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - James B. Kirkbride
- PsyLife Group, Division of Psychiatry, University College London, London, United Kingdom
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Pignon B, Szöke A, Ku B, Melchior M, Schürhoff F. Urbanicity and psychotic disorders: Facts and hypotheses. DIALOGUES IN CLINICAL NEUROSCIENCE 2023; 25:122-138. [PMID: 37994794 PMCID: PMC10986450 DOI: 10.1080/19585969.2023.2272824] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/16/2023] [Indexed: 11/24/2023]
Abstract
In the present qualitative literature review, we summarise data on psychotic disorders and urbanicity, focusing particularly on recent findings. Longitudinal studies of the impact of urbanicity on the risk for psychotic disorders have consistently shown a significant association, with a relative risk between 2 and 2.5. However, most of the original studies were conducted in Western Europe, and no incidence studies were conducted in low- and middle-income countries. European studies suggest that neighbourhood-level social fragmentation and social capital may partly explain this association. Exposure to air pollution (positive association) and green space (negative association) may also be part of the explanation, but to date, available data do not make it possible to conclude if they act independently from urbanicity, or as part of the effect of urbanicity on psychotic disorders. Finally, several studies have consistently shown significant associations between the polygenic risk score for schizophrenia and urbanicity, with several possible explanations (pleiotropic effects, results of prodromic symptoms, or selection/intergenerational hypothesis). Thus, more studies are needed to understand the factors that explain the association between urbanicity and the risk of psychotic disorders. Further studies should account for the interdependence and/or interactions of different psychosocial and physical exposures (as well as gene-environment interactions), and explore this association in low- and middle-income countries.
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Affiliation(s)
- Baptiste Pignon
- AP-HP, Hôpitaux Universitaires “H. Mondor”, DMU IMPACT, INSERM, IMRB, translational Neuropsychiatry, Fondation FondaMental, Univ Paris-Est-Créteil (UPEC), Créteil, France
| | - Andrei Szöke
- AP-HP, Hôpitaux Universitaires “H. Mondor”, DMU IMPACT, INSERM, IMRB, translational Neuropsychiatry, Fondation FondaMental, Univ Paris-Est-Créteil (UPEC), Créteil, France
| | - Benson Ku
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d‘Épidémiologie Et de Santé Publique, IPLESP, Equipe de Recherche en Epidémiologie Sociale, ERES, Paris, France
| | - Franck Schürhoff
- AP-HP, Hôpitaux Universitaires “H. Mondor”, DMU IMPACT, INSERM, IMRB, translational Neuropsychiatry, Fondation FondaMental, Univ Paris-Est-Créteil (UPEC), Créteil, France
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Thomas M, Rakesh D, Whittle S, Sheridan M, Upthegrove R, Cropley V. The neural, stress hormone and inflammatory correlates of childhood deprivation and threat in psychosis: A systematic review. Psychoneuroendocrinology 2023; 157:106371. [PMID: 37651860 DOI: 10.1016/j.psyneuen.2023.106371] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/20/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023]
Abstract
Childhood adversity increases the risk of developing psychosis, but the biological mechanisms involved are unknown. Disaggregating early adverse experiences into core dimensions of deprivation and threat may help to elucidate these mechanisms. We therefore systematically searched the literature investigating associations between deprivation and threat, and neural, immune and stress hormone systems in individuals on the psychosis spectrum. Our search yielded 74 articles, from which we extracted and synthesized relevant findings. While study designs were heterogeneous and findings inconsistent, some trends emerged. In psychosis, deprivation tended to correlate with lower global cortical volume, and some evidence supported threat-related variation in prefrontal cortex morphology. Greater threat exposure was also associated with higher C-reactive protein, and higher and lower cortisol measures. When examined, associations in controls were less evident. Overall, findings indicate that deprivation and threat may associate with partially distinct biological mechanisms in the psychosis spectrum, and that associations may be stronger than in controls. Dimensional approaches may help disentangle the biological correlates of childhood adversity in psychosis, but more studies are needed.
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Affiliation(s)
- Megan Thomas
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Australia.
| | - Divyangana Rakesh
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Australia; Neuroimaging Department, Institute of Psychology, Psychiatry & Neuroscience, King's College London, London, United Kingdom
| | - Sarah Whittle
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Australia
| | - Margaret Sheridan
- Department of Psychology & Neuroscience, University of North Carolina, United States
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, United Kingdom; Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, United Kingdom
| | - Vanessa Cropley
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Australia
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Davies M, Horsdal HT, Antonsen S, Sigsgaard T, Fan CC, Thompson WK, Pedersen CB, Sabel CE. The complexities of suicide: a multilevel survival analysis examining individual, familial and neighbourhood determinants of suicide risk using Danish register-based data. Psychol Med 2023; 53:6356-6365. [PMID: 36515183 DOI: 10.1017/s0033291722003701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Suicide risk is complex and nuanced, and how place impacts suicide risk when considered alongside detailed individual risk factors remains uncertain. We aimed to examine suicide risk in Denmark with both individual and neighbourhood level risk factors. METHODS We used Danish register-based data to identify individuals born in Denmark from 1972, with full parental information and psychiatric diagnosis history. We fitted a two-level survival model to estimate individual and neighbourhood determinants on suicide risk. RESULTS We identified 1723 cases of suicide in Denmark during the follow-up period from 1982 to 2015. Suicide risk was explained mainly by individual determinants. Parental comorbidities, particularly maternal schizophrenia [incidence rate ratio (IRR): 2.29, 95% CI 1.56-3.16] and paternal death (2.29, 95% CI 1.31-3.72) partly explained suicide risk when adjusted for all other determinants. The general contextual effect of suicide risk across neighbourhoods showed a median incidence rate ratio (MRR) of 1.13 (1.01-1.28), which was further reduced with full adjustment. Suicide risk increased in neighbourhoods with a higher proportion of manual workers (IRR: 1.08; 1.03-1.14), and decreased with a higher population density (IRR: 0.89; 0.83-0.96). CONCLUSION Suicide risk varies mainly between individuals, with parental comorbidities having the largest effect on suicide risk. Suicide risk was less impacted by neighbourhood, though, albeit to a lesser extent than individual determinants, some characteristics were associated with suicide risk. Suicide prevention policies might consider targeting interventions towards individuals more vulnerable due to particular parental comorbidities, whilst taking into account that some neighbourhood characteristics might exacerbate this risk further.
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Affiliation(s)
- Megan Davies
- Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
- BERTHA Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark
| | - Henriette Thisted Horsdal
- BERTHA Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
| | - Sussie Antonsen
- BERTHA Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
| | - Torben Sigsgaard
- BERTHA Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Chun Chieh Fan
- Department of Radiology, Population Neuroscience and Genetics Lab, University of California San Diego, La Jolla, CA, USA
| | - Wesley K Thompson
- Division of Biostatistics and Department of Radiology, Population Neuroscience and Genetics Lab, University of California San Diego, La Jolla, CA, USA
| | - Carsten Bøcker Pedersen
- BERTHA Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Aarhus, Denmark
| | - Clive E Sabel
- BERTHA Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Health Research Institute, University of Canberra, Canberra, Australia
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11
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Fordham E, Gao CX, Filia K, O'Donoghue B, Smith C, Francey S, Rickwood D, Telford N, Thompson A, Brown E. Social disadvantage in early psychosis and its effect on clinical presentation and service access, engagement and use. Psychiatry Res 2023; 328:115478. [PMID: 37717545 DOI: 10.1016/j.psychres.2023.115478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 09/19/2023]
Abstract
Incidence of psychosis varies geographically due to factors such as social disadvantage. Whether this influences the clinical presentation and/or engagement of those experiencing psychosis remains relatively understudied. This study analysed data from young people across Australia accessing ultra-high risk (UHR) or first episode psychosis (FEP) services delivered through the headspace Early Psychosis (hEP) program between June 2017 and March 2021. The cohort was categorised into low, middle, and high tertiles of social disadvantage using the Index of Relative Socioeconomic Disadvantage (IRSD). Data from 3089 participants aged 15-25 were included (1515 UHR, 1574 FEP). The low and middle tertiles for both cohorts had greater percentages of those not in education or employment (NEET), with First Nations or culturally and linguistically diverse backgrounds. Clinical presentations to services were similar across all tertiles in both cohorts, however, functioning at presentation varied significantly within the FEP cohort. Significantly lower numbers of direct services were provided in the low tertile of both cohorts, with significantly poorer engagement in the initial three-months also occurring for these young people. This variation in early psychosis service patterns associated with geographical variation in social deprivation demonstrates the need for further research and fine tuning of national early psychosis services.
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Affiliation(s)
- Eliza Fordham
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - Caroline X Gao
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Australia; School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kate Filia
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - Brian O'Donoghue
- Centre for Youth Mental Health, University of Melbourne, Australia; Department of Psychiatry, University College Dublin, Ireland
| | - Catherine Smith
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - Shona Francey
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - Debra Rickwood
- Headspace National, Melbourne, Australia; University of Canberra, Australia
| | | | - Andrew Thompson
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - Ellie Brown
- Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Australia.
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12
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Chen THK, Horsdal HT, Samuelsson K, Closter AM, Davies M, Barthel S, Pedersen CB, Prishchepov AV, Sabel CE. Higher depression risks in medium- than in high-density urban form across Denmark. SCIENCE ADVANCES 2023; 9:eadf3760. [PMID: 37224254 PMCID: PMC10208571 DOI: 10.1126/sciadv.adf3760] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 04/19/2023] [Indexed: 05/26/2023]
Abstract
Urban areas are associated with higher depression risks than rural areas. However, less is known about how different types of urban environments relate to depression risk. Here, we use satellite imagery and machine learning to quantify three-dimensional (3D) urban form (i.e., building density and height) over time. Combining satellite-derived urban form data and individual-level residential addresses, health, and socioeconomic registers, we conduct a case-control study (n = 75,650 cases and 756,500 controls) to examine the association between 3D urban form and depression in the Danish population. We find that living in dense inner-city areas did not carry the highest depression risks. Rather, after adjusting for socioeconomic factors, the highest risk was among sprawling suburbs, and the lowest was among multistory buildings with open space in the vicinity. The finding suggests that spatial land-use planning should prioritize securing access to open space in densely built areas to mitigate depression risks.
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Affiliation(s)
- Tzu-Hsin Karen Chen
- School of the Environment, Yale University, New Haven, CT, USA
- Yale Institute for Biospheric Studies, Yale University, New Haven, CT, USA
- Department of Urban Design and Planning, University of Washington, Seattle, WA, USA
- Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus V, Denmark
- Department of Geosciences and Natural Resource Management (IGN), University of Copenhagen, København V, Denmark
| | - Henriette Thisted Horsdal
- Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus V, Denmark
- The National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus V, Denmark
| | - Karl Samuelsson
- ISGlobal, Barcelona, Spain
- Department of Building Engineering, Energy Systems and Sustainability Science, University of Gävle, Gävle, Sweden
- Department of Geospatial and Computer Sciences, University of Gävle, Gävle, Sweden
| | - Ane Marie Closter
- Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus V, Denmark
- The National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus V, Denmark
| | - Megan Davies
- Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus V, Denmark
- Section of Epidemiology, University of Copenhagen, København K, Denmark
| | - Stephan Barthel
- Department of Building Engineering, Energy Systems and Sustainability Science, University of Gävle, Gävle, Sweden
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
| | - Carsten Bøcker Pedersen
- Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus V, Denmark
- The National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus V, Denmark
- Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus V, Denmark
| | - Alexander V. Prishchepov
- Department of Geosciences and Natural Resource Management (IGN), University of Copenhagen, København V, Denmark
| | - Clive E. Sabel
- Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus V, Denmark
- Department of Public Health, Aarhus University, Aarhus V, Denmark
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13
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Ejlskov L, Antonsen S, Wulff JN, Agerbo E, Plana-Ripoll O, Sabel CE, Fan CC, Thompson WK, Mok PLH, Pedersen CB, Webb RT. Multilevel interactions between family and neighbourhood socioeconomic indices in childhood and later risks of self-harm and violent criminality in Denmark: a national cohort study. Lancet Public Health 2023; 8:e99-e108. [PMID: 36709062 PMCID: PMC9896147 DOI: 10.1016/s2468-2667(22)00292-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND A socioeconomically disadvantaged childhood has been associated with elevated self-harm and violent criminality risks during adolescence and young adulthood. However, whether these risks are modified by a neighbourhood's socioeconomic profile is unclear. The aim of our study was to compare risks among disadvantaged young people residing in deprived areas versus risks among similarly disadvantaged individuals residing in affluent areas. METHODS We did a national cohort study, using Danish interlinked national registers, from which we delineated a longitudinal cohort of people born in Denmark between Jan 1, 1981, and Dec 31, 2001, with two Danish-born parents, who were alive and residing in the country when they were aged 15 years, who were followed up for a hospital-treated self-harm episode or violent crime conviction. A neighbourhood affluence indicator was derived based on nationwide income quartiles, with parental income and educational attainment indicating the socioeconomic position of each cohort member's family. Bayesian multilevel survival analyses were done to examine the moderating influences of neighbourhood affluence on associations between family socioeconomic position and sex-specific risks for the two adverse outcomes. FINDINGS 1 084 047 cohort members were followed up for 12·8 million person-years in aggregate. Individuals of a low socioeconomic position residing in deprived neighbourhoods had a higher incidence of both self-harm and violent criminality compared with equivalently disadvantaged peers residing in affluent areas. Women from a low-income background residing in affluent areas had, on average, 95 (highest density interval 76-118) fewer self-harm episodes and 25 (15-41) fewer violent crime convictions per 10 000 person-years compared with women of an equally low income residing in deprived areas, whereas men of a low income residing in affluent areas had 61 (39-81) fewer self-harm episodes and 88 (56-191) fewer violent crime convictions per 10 000 person-years than men of a low income residing in deprived areas. INTERPRETATION Even in a high-income European country with comprehensive social welfare and low levels of poverty and inequality, individuals residing in affluent neighbourhoods have lower risks of self-harm and violent criminality compared with individuals residing in deprived neighbourhoods. More research is needed to explore the potential of neighbourhood policies and interventions to reduce the harmful effects of growing up in socioeconomically deprived circumstances on later risk of self-harm and violent crime convictions. FUNDING European Research Council, Lundbeck Foundation Initiative for Integrative Psychiatric Research, and BERTHA, the Danish Big Data Centre for Environment and Health funded by the Novo Nordisk Foundation Challenge Programme.
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Affiliation(s)
- Linda Ejlskov
- National Centre for Register-Based Research, Aarhus Business and Social Sciences, Aarhus University, Aarhus, Denmark; Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
| | - Sussie Antonsen
- National Centre for Register-Based Research, Aarhus Business and Social Sciences, Aarhus University, Aarhus, Denmark; Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark
| | - Jesper N Wulff
- Department of Econometrics and Business Analytics, Aarhus University, Aarhus, Denmark
| | - Esben Agerbo
- National Centre for Register-Based Research, Aarhus Business and Social Sciences, Aarhus University, Aarhus, Denmark; Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Oleguer Plana-Ripoll
- National Centre for Register-Based Research, Aarhus Business and Social Sciences, Aarhus University, Aarhus, Denmark; Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark; Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Clive E Sabel
- Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Chun Chieh Fan
- Department of Radiology, Population Neuroscience and Genetics Lab, University of California San Diego, La Jolla, CA, USA
| | - Wesley K Thompson
- Division of Biostatistics and Department of Radiology, Population Neuroscience and Genetics Lab, University of California San Diego, La Jolla, CA, USA
| | - Pearl L H Mok
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Carsten Bøcker Pedersen
- National Centre for Register-Based Research, Aarhus Business and Social Sciences, Aarhus University, Aarhus, Denmark; Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark; Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Roger T Webb
- Division of Psychology and Mental Health, Faculty of Biology, Medicine & Health, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK; National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
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14
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Spyridonidis S, Dykxhoorn J, Hollander AC, Dalman C, Kirkbride JB. Neighborhood-Level Predictors of Age-at-First-Diagnosis of Psychotic Disorders: A Swedish Register-Based Cohort Study. SCHIZOPHRENIA BULLETIN OPEN 2022; 3:sgac045. [PMID: 39144780 PMCID: PMC11205874 DOI: 10.1093/schizbullopen/sgac045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
The relationship between neighborhood-level factors and the incidence of psychotic disorders is well established. However, it is unclear whether neighborhood characteristics are also associated with age-at-first-diagnosis of these disorders. We used linked Swedish register data to identify a cohort of persons first diagnosed with an ICD-10 non-affective or affective psychotic disorder (F20-33) between 1997 and 2016. Using multilevel mixed-effect linear modelling, we investigated whether neighborhood deprivation and population density at birth were associated with age-at-first diagnosis of a psychotic disorder. Our final cohort included 13,440 individuals, with a median age-at-first-diagnosis of 21.8 years for women (interquartile range [IQR]: 19.0-25.5) and 22.9 years for men (IQR: 20.1-26.1; P < .0001). In an unadjusted model, we found no evidence of an association between neighborhood deprivation and age-at-first-diagnosis of psychotic disorder (P = .07). However, after multivariable adjustment, age-at-first-diagnosis increased by .13 years (95% CI: .05 to .21; P = .002) for a one standard deviation increase in neighborhood deprivation. This was equivalent to a later diagnosis of 47 days (95% CI: 18 to 77). We found no evidence of a different relationship for non-affective versus affective psychoses [LRT χ 2(1) = .14; P = .71]. Population density was not associated with age-at-first-diagnosis in unadjusted (P = .81) or adjusted (P = .85) models. Later age-at-first-diagnosis for individuals born in more deprived neighborhoods suggests structural barriers in accessing equitable psychiatric care.
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Affiliation(s)
| | - Jennifer Dykxhoorn
- PsyLife Group, Division of Psychiatry, UCL, London, UK
- Department of Primary Care and Population Health, UCL, London, UK
| | | | - Christina Dalman
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Sweden
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